Faculty Bibliography

Clinical ethics and the resolution of ethical problems have traditionally been addressed through the use of "passed down" acts or statements that have been developed over time through a combination of written professional codes of conduct and unwritten protocol established and accepted by various professional cliques. This article presents an approach to dealing with chairside ethical dilemmas that balances accepted ethical principles such as Autonomy, Beneficence, Fidelity, Justice, Informed Consent, and Publicity as well as other concepts relative to the facts presented and to the parties involved. Party prioritization, value systems, and a schematic for analyzing chairside ethical problems is also presented. In addition, several case scenarios are presented for evaluation and discussion by the reader.

The gluteal region is an excellent donor site for autogenous breast reconstruction, particularly when the lower abdomen is not suitable. The superior gluteal perforator flap involves microsurgical transfer of skin and fat from the buttock without muscle sacrifice. Gluteal myocutaneous flaps have been described, but they have several problems, including a short vascular pedicle, exposure of the sciatic nerve, and recipient vessel size discrepancy needing vein grafts.

Surgical resection of aggressive solid or multicystic ameloblastoma is a well-documented and accepted treatment modality. Controversies exist, however, with regard to the extent of operative intervention. Unresectable lesions have been treated with radiation or combined radiation and chemotherapy. The authors present a case report of a patient with recurrent ameloblastoma who underwent simultaneous hard- and soft-tissue reconstruction.

"Managing Your OR" focuses on various aspects of aesthetic surgery in the ambulatory surgical setting.

The authors substantial experience with the superior gluteal free flap for breast reconstruction indicates that this is a more difficult but important free flap for breast reconstruction. Compared with the standard transverse rectus abdominis myocutaneous (TRAM) free flap, it is a much less forgiving operation with many specific technical details. With careful attention to details on flap design, recipient vessel selection anastomsis, and flap insetting, the success rate and morbidity of the gluteal flap operation are highly acceptable. For patients unsuitable for the TRAM flap for autologous tissue reconstruction, this is a very valuable alternative. It can achieve some spectacular results in breast reconstruction in terms of volume, replacement, and projection--even in very thin patients.

Since the early 1800s, studies have consistently demonstrated that people higher in the socioeconomic hierarchy live longer than people of lower rank. One hypothesis for the persistence of this association is that people who are relatively better off are more able to avoid risks by adopting currently available protective strategies. In a partial test of this idea, the social distributions of two cancer screening tests--Pap smears and mammography--were examined. A review of the literature and an analysis of Behavioral Risk Factor Surveillance System (BRFSS) data showed a consistent association between indicators of socioeconomic status and recent screening. These findings support the theory that societies create and shape patterns of disease. Innovations beneficial to health are carried out within the context of inequalities that shape the distribution of the health benefit, thereby affecting patterns of morality.

OBJECTIVES: This study compared dietary risk factors among Southern-born and other Blacks in Central Harlem. METHODS: A survey of residents of Central Harlem was used to compute a "healthy diet" score for 621 subjects. RESULTS: Southern-born respondents had the highest-risk diets. Although their numbers were small, Caribbean-born respondents, particularly those younger than 45 years, had the lowest-risk diets. CONCLUSIONS: The variation in diets in Central Harlem was considerable, with Southern-born Blacks at highest dietary risk for chronic diseases. These results remain to be tested elsewhere, as does the contribution of other chronic disease risk factors.

The New York City neighborhood of Harlem has mortality rates that are among the highest in the United States. In absolute numbers, cardiovascular disease and cancer account for the overwhelming majority of deaths, especially among men, and these deaths occur at relatively young ages. The aim of this research was to examine self-reported smoking habits according to measures of socioeconomic status among Harlem men and women, in order to estimate the contribution of tobacco consumption to Harlem's remarkably high excess mortality. During 1992-1994, in-person interviews were conducted among 695 Harlem adults aged 18-65 years who were randomly selected from dwelling unit enumeration lists. The self-reported prevalence of current smoking was strikingly high among both men (48%) and women (41%), even among highly educated men (38%). The 21% of respondents without working telephones reported an even higher prevalence of current smoking (61%), indicating that national and state-based estimates which rely on telephone surveys may seriously underestimate the prevalence of smoking in poor urban communities. Among persons aged 35-64 years, the smoking attributable fractions for selected causes of death were larger in Harlem than in either New York City as a whole or the entire United States for both men and women. Tobacco consumption is likely to be one of several important mediators of the high numbers of premature deaths in Harlem.

An unusual case of synovial chondromatosis of the temporomandibular joint with intracranial extension, which resulted in complete dehiscence of the floor of the middle cranial fossa, is reported. An overview of the current literature and a discussion of the diagnosis and surgical management of synovial chondromatosis are presented.